Technical Field
[0001] The present invention relates to methods of detecting cerebral stroke or asymptomatic
cerebral infarction using the contents of acrolein, and interleukin-6 and CRP which
are inflammatory markers, polyamine oxidase activity or polyamine oxidase protein
contents and subjects' ages as indications.
Background Art
[0002] In Japan, the number of deaths caused by cerebrovascular diseases is the third largest
after those by neoplasm malignants and cardiac diseases. Sequela following the affection
of the cerebrovascular diseases not only pose serious problems for patients in the
daily life of their own, e.g., involving paralysis or akinesia, but also contribute
to increased psychic stress on caregivers. Cerebral stroke which is the majority of
the cerebrovascular diseases is a disease difficult to early detect and early treat.
Although initiation of treatment of patients in the stages of cerebral infarctions
without any subjective symptoms of cerebral infarctions, such as hemiplegia, hemiparesis,
numbness, decreased sensation, hand-foot movement disorders, disturbance of consciousness
and language disorders, (asymptomatic cerebral infarctions) is effective, the majority
of cases with asymptomatic cerebral infarctions are accidentally found using diagnostic
imaging and there are no diagnosis marker for utilized in, e.g., blood examination
or urinalysis under present circumstances. Therefore, development of simple and highly-reliable
diagnosis methods which are not methods requiring expensive devices, such as diagnostic
imaging, is desired.
[0003] Acrolein and polyamine oxidases generating it from polyamine have been known as biomarkers
having correlations with cerebral infarction. Acrolein is detoxicated by aldehyde
dehydrogenase in a cell but, when leaked extracellularly, demonstrates a strong toxicity.
Therefore, acrolein is considered to have a high correlation with a cell injury score,
and thus its correlations with symptoms such as renal disorders, cerebral stroke and
asymptomatic cerebral infarction have been studies. See non-patent documents 1 to
3 and patent documents 1 and 2.
Non-Patent Document 1
Sakata, K. et al (2003) Biochem. Biophys. Res. Commun. 305, 143-149
Non-Patent Document 2
Tomitori, H. et al (2005) Stroke 36, 2609-2613
Non-Patent Document 3
Igarashi, K. et al (2006) Amino Acids 31, 477-483
Patent Document 1
Japanese Unexamined Patent Application Publication No. 2002-95942
Patent Document 2
Japanese Unexamined Patent Application Publication No. 2005-304476
[0004] However, for example, the accuracy of conventional diagnosis and screening methods
for cerebral stroke and asymptomatic cerebral infarction based on acrolein or polyamine
oxidase activity as described in the patent document 2 was still not sufficient, particularly
in terms of practical use.
[0005] In contrast, interleukin-6, which was found as a B cell differentiation-inducing
factor, is known to be a malignant cell growth factor for multiple myeloma and to
be involved in various inflammatory diseases and autoimmune diseases. Therefore, studies
of interleukin-6 as a biomarker for cerebral stroke have been conducted. See non-patent
documents 4 and 5 and a patent document 3.
[0006] CRP (C-reactive protein) was also found as a serum protein (β-globulin) which undergoes
a precipitation reaction with C-polysaccharide extracted from a cell wall in
Streptococcus pneumoniae, and blood CRP concentrations are known to be increased in many diseases such as
infections (particularly, bacterial infections), myocardial infarction and autoimmune
diseases. In recent years, technological improvement in measuring devices has leaded
to development of methods for measuring high sensitivity CRP (hs-CRP), which allow
sensing of even extremely mild inflammatory reactions without definite inflammatory
diseases such as infections and malignant tumors (minimum detectable sensitivity:
0.01 mg/L). In a large clinical study by Ridker et al., CRP was reported to become
an independent prediction marker for ischemic heart disease. Therefore, studies of
CRP as a biomarker for cerebral stroke have been conducted. See non-patent documents
6, 7 and 8 and a patent document 3.
Non-Patent Document 4
Smith, C. J. et al (2004) BMC Neurol. 15, 4:2
Non-Patent Document 5
Tzoulaki, I. et al (2006) Circulation. 115, 2119-2127
Non-Patent Document 6
Ridker PM. et al (2002) Engl J Med 347, 1557-1565
Non-Patent Document 7
Wakugawa, Y. et al (2006) Stroke 37, 27-32
Non-Patent Document 8
Tzoulaki, I. et al (2006) Circulation. 115, 2119-2127
Patent Document 3
Japanese Unexamined Patent Application Publication No. 2005-522669
[0007] However, there are no cases of using interleukin-6 or CRP individually as a biomarker
for diagnosis of cerebral infarction, and a technique of distinguishing the stroke
type of a patient after the onset of a cerebral stroke symptom in combination of interleukin-6
or CRP with B-type natriuretic peptide, matrix metalloprotease-9, S-100β, thrombin-antithrombin
III complex and one or more types of von Willebrand factors is disclosed. Furthermore,
neither suggestion nor teaching about the relationships of, in particular, samples
from patients with asymptomatic cerebral infarction before the onset of stroke symptoms,
with interleukin-6 and CRP are given.
Disclosure of the Invention
Problems to be Solved by the Invention
[0008] Therefore, an object of the invention is to provide a method of detecting or screening
cerebral stroke or asymptomatic cerebral infarction at an elevated accuracy and so
on, as being able to be practically used.
Means for Solving the Problems
[0009] As a result of extensive research to achieve the above-mentioned object, the present
inventors found that the values which are obtained newly by mathematically statistically
analyzing the contents of acrolein, and interleukin-6 and CRP which are inflammatory
markers, in subject samples, polyamine oxidase activity and subjects' ages are significantly
statistically correlated with whether or not to have asymptomatic cerebral infarction,
and the invention was thus accomplished based on the results.
[0010] More specifically, the present invention includes each aspect as described below.
[0011]
- (1) A method of detecting cerebral stroke or asymptomatic cerebral infarction, comprising
measuring the contents of a aldehyde compound formed from polyamine, interleukin-6
and C-reactive protein, polyamine oxidase activity or a polyamine oxidase protein
content in a biological sample obtained from a subject and using the measurement data
thus obtained and a subject's age as indications.
- (2) The method according to a first aspect of the present invention, wherein the aldehyde
compound formed from the polyamine is acrolein.
- (3) The method according to a first or second aspect of the present invention, further
comprising: measuring the contents of the aldehyde compound formed from the polyamine,
the interleukin-6 and the C-reactive protein, the polyamine oxidase activity or the
polyamine oxidase protein content in the biological sample; carrying out mathematically
statistical analysis of the measurement data thus obtained and a subject's age, thereby
obtaining a value which exhibits a statistically significant change; and detecting
cerebral stroke or asymptomatic cerebral infarction based on the value.
- (4) The method according to a third aspect of the present invention, further comprising
carrying out the mathematically statistical analysis by a neural network technique.
- (5) A kit for detecting cerebral stroke or asymptomatic cerebral infarction, comprising
a reagent for measuring the contents of an aldehyde compound formed from polyamine,
interleukin-6 and C-reactive protein, polyamine oxidase activity or a polyamine oxidase
protein content in a biological sample.
- (6) A system for detecting cerebral stroke or asymptomatic cerebral infarction, comprising:
a reagent for measuring the contents of a aldehyde compound formed from polyamine,
interleukin-6 and C-reactive protein, polyamine oxidase activity or a polyamine oxidase
protein content in a biological sample; and an electronic treating device and software
for carrying out mathematically statistical analysis.
Advantages of the Invention
[0012] The method according to an aspect of the present invention allows detection of a
patient with cerebral stroke or an asymptomatic patient at a high accuracy of about
95%. Accordingly, a patient with cerebral stroke or asymptomatic cerebral infarction
can be detected and diagnosed early before developing a symptom of cerebral infarction,
or can be screened.
Brief Description of the Drawings
[0013]
FIG. 1 shows each ROC curve, cutoff value, sensitivity, specificity, predictive value
and likelihood ratio in a combination of subjects' ages with one selected from four
plasma biomarkers (polyamine oxidase, acrolein, interleukin-6 and CRP) in a group
of patients with asymptomatic cerebral infarction, and healthy subjects;
FIG. 2 shows each ROC curve, cutoff value, sensitivity, specificity, predictive value
and likelihood ratio in a combination of the subjects' ages and the acrolein with
one selected from the other three plasma biomarkers (the polyamine oxidase, the interleukin-6
and the CRP) in the group of the patients with asymptomatic cerebral infarction, and
the healthy subjects;
FIG. 3 shows each ROC curve, cutoff value, sensitivity, specificity, predictive value
and likelihood ratio in a combination of the subjects' ages, the acrolein and the
interleukin-6 with one selected from the other two plasma biomarkers (the polyamine
oxidase and the CRP) in the group of the patients with asymptomatic cerebral infarction,
and the healthy subjects; and
FIG. 4 shows an ROC curve, a cutoff value, a sensitivity, a specificity, a predictive
value and a likelihood ratio using the subjects' ages, the acrolein, the polyamine
oxidase, the interleukin-6 and the CRP in the group of the patients with asymptomatic
cerebral infarction, and the healthy subjects.
Best Mode for Carrying Out the Invention
[0014] A most preferred embodiment of the present invention will be described in detail
below, but many other different embodiments according to the present invention, which
are apparent to those skilled in the art, are possible, and the present invention
is not limited to the embodiment described below.
[0015] The biological samples from the subjects, used in the method according to an aspect
of the present invention, are preferably plasma used in an example as described below.
However, other biological samples can also be used appropriately. Such other biological
samples can include, for example, urine, saliva, cerebral spinal fluid and bone marrow
fluid.
[0016] The term "polyamine" herein refers to a straight-chain aliphatic hydrocarbon having
two or more primary amino groups. Known biogenic polyamines may include, but are not
limited to, putrescine, cadaverine, spermidine, spermine, 1,3-diaminopropane, caldine,
homospermidine, 3-aminopropylcadaverine, norspermine, thermospermine, caldopentamine,
and so on. Preferred polyamines in accordance with an aspect of the present invention
may be putrescine, spermidine and spermine.
[0017] The above polyamines are metabolized by oxidation, acetylation, transamination or
carbamoylation, and a polyamine oxidase (acetylpolyamine oxidase (AcPAO) or spermine
oxidase (SMO)) is an enzyme involved in the oxidation of polyamines. The term "polyamine
oxidase" herein refers to an enzyme that oxidizes a diamine or a polyamine as a good
substrate and generates hydrogen peroxide. Such a polyamine is oxidatively deaminated
by a polyamine oxidase, resulting formation of aldehyde compounds such as acrolein.
In accordance with an aspect of the present invention, such a preferred aldehyde compound
may be acrolein, but is not limited thereto.
[0018] A plasma acrolein content can be determined by any procedure well-known to those
skilled in the art, for example, measuring the content of FDP-lysine (N-formyl-piperidino-lysine),
which is an amino acid adder with acrolein. An FDP-lysine content can be measured,
for example, by using ACR-LYSINE ADDUCT ELISA SYSTEM (NOF CORPORATION), according
to the attached manual. The acrolein content may also be measured in the form of derivatives
other than FDP-lysine. Furthermore, it is also possible to measure the acrolein content
directly, and such a procedure is described in a report, for example, by Alarcon et
al. (
Alarcon, R. A. (1968) Anal. Chem. 40, 1704-1708). However, there is such a problem that the reactivity of acrolein with other molecules
is high so that the amount of free acrolein in the blood is very small. Thus, considering
the measurement of acrolein in the form of FDP-lysine is simple and easy, it is a
preferred aspect in the present invention to measure acrolein in the form of FDP-lysine.
[0019] Specifically, subject plasma and a standard solution are dispensed into a plate immobilized
with antigen by 50 µl/well, and further the same amount of primary antibody solution
is added. The fluid is removed after left at rest for 30 minutes at room temperature
and washed with a washing solution, followed by dispensing 100 µl/well of secondary
antibody solution. It is washed with the washing solution after left at rest for 1
hour at room temperature, then color is developed by adding a coloring reagent of
100 µl/well and leaving it at rest for 15 minutes at room temperature, and reaction
stop solutions are dispensed by 50 µl/well, followed by determining the absorbance
at 450 nm using a plate reader. A plasma acrolein content is displayed as an FDP-lysine
content per milliliter of plasma (nmol/ml plasma).
[0020] A plasma interleukin-6 content can be measured by any procedure well-known to those
skilled in the art, for example, by using Human IL-6 ELISA (ENDOGEN CORPORATION),
according to the attached manual.
[0021] Specifically, primary antibody solutions are dispensed into a 98-well plate by 50
µl/well, and further the same amounts of subject plasma and standard solution are
added. The fluid is removed after left at rest for 2 hours at room temperature and
washed with a washing solution, followed by dispensing 100 µl/well of secondary antibody
solution. It is washed with the washing solution after left at rest for 30 minutes
at room temperature, then color is developed by adding a coloring reagent of 100 µl/well
and leaving it at rest for 30 minutes at room temperature, and reaction stop solutions
are dispensed by 100 µl/well, followed by determining the absorbance at 450 nm using
a plate reader. A plasma interleukin-6 content is displayed as a plasma content per
milliliter of plasma (pg/ml plasma).
[0022] A plasma CRP content can be measured by any procedure well-known to those skilled
in the art, for example, by using Human CRP ELISA KIT (Alpha Diagnostics International,
Inc.), according to the attached manual.
[0023] Specifically, each well is washed with a washing solution, followed by dispensing
subject plasma and standard solution into a 98-well plate by 10 µl/well and further
adding an abzyme labeling solution of 100 µl/well. The fluid is removed after left
at rest for 30 minutes at room temperature and washed with a washing solution. A coloring
reagent is added, color is developed while shaking the mixture for 10 minutes at room
temperature, and reaction stop solutions are dispensed by 50 µl/well, followed by
determining the absorbance at 450 nm using a plate reader. A plasma CRP content is
displayed as a CRP content per milliliter of patient plasma (mg/dl plasma).
[0024] The measurement of the activities of polyamine oxidases (AcPAO and SMO) can be conducted
by any procedure well-known to those skilled in the art, for example, by incubating
0.06 ml of reaction mixture containing 10 mM Tris-hydrochloric acid (pH 7.5), 0.2
mM substrate (acetyl spermine or spermine) and 0.05 ml of patient plasma for 48 hours
at 37°C. Trichloroacetic acid (TCA) is added to 0.02 ml of the reaction mixture to
a final concentration of 5%, and it is centrifuged. A part of obtained supernatant
is used for polyamine assay. Polyamine oxidase activity can be displayed as the content
of a spermidine generated by the decomposition of acetyl spermine or spermine per
milliliter of patient plasma (nmol/ml plasma).
[0025] The procedures of measuring the enzyme activity of polyamine oxidase are described
in various reports, which may include a report by Sharmin et al. (
Sharmin et al., (2001) Biochem. Biophys. Res. Commun. 282, 228-235), a report by Sakata et al. (
Sakata et al., (2003) Biochem. Biophys Res. Commun. 305, 143-149), and a report by Igarashi et al. (
Igarashi et al., (1986) J. Bacteriol. 166, 128-134). Based on the descriptions of such reports, those skilled in the art can measure
the enzymatic activity of polyamine oxidase by making appropriate modifications.
[0026] Furthermore, the protein content of polyamine oxidase can be measured by any procedure
well-known to those skilled in the art, for example, by enzyme-linked immunosorbent
assay (EILSA), western blotting analysis or immunoprecipitation method using a specific
antibody for polyamine oxidase. Such procedures are heretofore known and commonly
used, and therefore, those skilled in the art can measure the protein content of the
enzyme using the above procedures by setting adequate conditions appropriately. An
antibody against polyamine oxidase used for conducting these measurements may be a
monoclonal antibody or a polyclonal antibody.
[0027] The polyclonal antibody against polyamine oxidase can be obtained, for example, by
immunizing rabbits with the peptide fragment of polyamine oxidase by using a conventional
technique for production of a peptide antibody. The production of a peptide antibody
can be confirmed through assaying whether the antibody has reached to sufficient titer
by collecting blood from rabbits administered with the peptide and measuring its antibody
titer. The procedures for producing a peptide antibody are described in various experimental
manuals and well known to those skilled in the art, so the antibody against polyamine
oxidase can be obtained by making various modifications based on those descriptions.
[0028] In accordance with an aspect of the present invention, the contents of an aldehyde
compound formed from polyamine, interleukin-6 and C-reactive protein, polyamine oxidase
activity or a polyamine oxidase protein content in the biological sample are measured;
mathematically statistical analysis of the measurement data thus obtained and a subject's
age is carried out, thereby consequently obtaining a value which exhibits a statistically
significant change; and cerebral stroke or asymptomatic cerebral infarction can be
detected based on the value.
[0029] The mathematical statistical analysis may be carried out by using procedures well-known
to those skilled in the art, preferably by using a neural network technique. The neural
network technique can be conducted, for example, by using NEUROSIM/L (Fujitsu Ltd.),
according to the attached manual.
[0030] "Cutoff value" is a value set for the detection of a specific disease. Asymptomatic
cerebral infarction can be detected using a value obtained as described above as "cutoff
value." Cerebral stroke or asymptomatic cerebral infarction can also be detected using
the value obtained as described above, which statistically significantly varies as
"cutoff value." For example, in a patient with asymptomatic cerebral infarction and
a healthy subject, an ROC (Receiver Operating Characteristic) curve is developed by
using commercially available statistical analysis software based on values obtained
by measuring the contents of the above biomarkers, the optimal sensitivity and specificity
are determined, and a cutoff value may be set depending on the purpose of detection,
for example, so that a higher sensitivity is given priority in detection for a purpose
such as primary screening and a specificity is higher in detection for the purpose
of close investigation.
[0031] Based on the findings in accordance with an aspect of the present invention, a method
of prophylaxis of cerebral stroke and prevention of progress of the symptom by suppressing
the contents of acrolein, and interleukin-6 and CRP which are inflammatory markers,
polyamine oxidase activity or these protein contents in a subject sample can also
be provided.
[0032] Furthermore, there is also provided a method of screening (exploration) of a new
drug which is effective for treatment of cerebral stroke by administering an experimental
animal with a candidate compound which may be effective for treatment of cerebral
stroke and assaying whether the compound has the activity of inhibiting the contents
of acrolein, and interleukin-6 and CRP which are inflammatory markers, polyamine oxidase
activity or these protein contents in the experimental animal.
[0033] In accordance with an aspect of the present invention, a kit for detecting cerebral
stroke or asymptomatic cerebral infarction is further provided. The kit comprises
a reagent for measuring the contents of a aldehyde compound formed from polyamine,
interleukin-6 and C-reactive protein, polyamine oxidase activity or a polyamine oxidase
protein content in a biological sample. Furthermore, e.g., any measuring instrument
or apparatus, standard solution and buffer well-known to those skilled in the art
may be optionally contained.
[0034] In accordance with an aspect of the present invention, there is also provided a system
for detecting cerebral stroke or asymptomatic cerebral infarction, comprising: a reagent
for measuring the contents of a aldehyde compound formed from polyamine, interleukin-6
and C-reactive protein, polyamine oxidase activity or a polyamine oxidase protein
content in a biological sample; and an electronic treating device and software for
carrying out mathematically statistical analysis. Such electronic treating devices
for carrying out mathematically statistical analysis may include, e.g., an appropriate
computer well-known to those skilled in the art; and such software for carrying out
mathematically statistical analysis may include, e.g., one allowing the above neural
network technique.
Example
[0035] Hereinafter, the present invention will be further concretely described referring
to an example concerning the construction of a cerebral infarction judgment model
employing an artificial neural network, but the invention is not limited thereto.
[0036] The presence or absence of infarction was examined by taking head tomographic images
by magnetic resonance imaging (MRI) with the permission and consent of subjects. An
as a result, the subject group was divided into 44 patients with asymptomatic cerebral
infarction and 53 healthy subjects. Blood was collected from the patients with asymptomatic
cerebral infarction and the healthy subjects to compare the contents of acrolein,
interleukin-6 (IL-6) and CRP and polyamine oxidase activity in plasma.
[0037] The plasma acrolein content was determined by measuring the content of FDP-lysine
(N-formyl-piperidino-lysine), which is an amino acid adder with acrolein. The above
procedure was conducted using ACR-LYSINE ADDUCT ELISA SYSTEM (NOF CORPORATION). The
plasma interleukin-6 content was measured by the above procedure using Human IL-6
ELISA (ENDOGEN CORPORATION). The plasma CRP content was measured by the above procedure
using Human CRP ELISA KIT (Alpha Diagnostics International, Inc.). The measurement
of the activities of polyamine oxidases (AcPAO and SMO) was conducted by the above
procedure.
[0038] To construct a neural network model, NEUROSIM/L version 4 (Fujitsu) was used as software,
and learning was conducted by an error back-propagation method at learning constants
of a learning rate (e) = 5.0 and a momentum term (a) = 0.4. In the neural network,
three input layers were set at five of plasma biomarkers (polyamine oxidase, acrolein,
interleukin-6 and CRP) and a subject's age, and, based on empirical rules, intermediate
and output layers were set at three and one, respectively. Values of "1" for the patients
with asymptomatic cerebral infarction and "0" for the healthy subjects were input
into teacher data in an output layer. Learning data were from 97 samples in total
consisting of 44 samples from the patients with asymptomatic cerebral infarction and
53 samples from the healthy subj ects.
[0039] To judge the presence or absence of asymptomatic cerebral infarction by the practical
detection of the images and to examine the accuracy of the results of prediction in
the neural network model, receiver operating characteristic (hereinafter, ROC) curve
analyses and areas under the ROC curve (AUC) were calculated using the predicted values
calculated by the above software analysis. GraphPad PRISM 4(GraphPad Software Corporation)
was used for the calculation of the ROC curve analyses and the AUCs. The accuracy
of the cutoff values was evaluated with sensitivity, specificity, predictive values
(positive and negative reaction predictive values) and likelihood ratios (positive
and negative likelihood ratios).
[0040] FIG. 1 shows the results of the ROC curve analyses in the combinations of the subjects'
ages with one selected from the four plasma biomarkers (polyamine oxidase, acrolein,
interleukin-6 and CRP) in the input layer. The compared AUCs of acrolein, interleukin-6,
polyamine oxidase and CRP were ranked in the descending order. The combination of
the ages with the interleukin-6 showed that the sensitivity and the specificity for
the prediction of asymptomatic cerebral infarction were 81.8% and 73.6%, respectively;
and these obtained results were comparable to those in the case of acrolein.
[0041] FIG. 2 shows the results of the ROC curve analyses in the combinations of the subjects'
ages and the acrolein with one selected from the other three plasma biomarkers (polyamine
oxidase, interleukin-6 and CRP) in the input layer. The compared AUCs of CRP, interleukin-6
and polyamine oxidase were ranked in the descending order. The combination of the
ages and the acrolein with the interleukin-6 showed that the sensitivity and the specificity
for the prediction of asymptomatic cerebral infarction were 88.6% and 86.8%, respectively,
exhibiting improvement in reaction predictive value compared to the results in FIG.
1.
[0042] FIG. 3 shows the results of the ROC curve analyses in the combinations of the subjects'
ages, the acrolein and the interleukin-6 with one selected from the other two plasma
biomarkers (polyamine oxidase and CRP) in the input layer. The combination of the
ages, the acrolein and the interleukin-6 with CRP showed that the sensitivity and
the specificity for the prediction of asymptomatic cerebral infarction were 88.6%
and 90.6%, respectively, exhibiting improvement in reaction predictive value compared
to the results in FIG. 2.
[0043] FIG. 4 shows the results of the ROC curve analyses in the combination of the subjects'
ages, the acrolein, the interleukin-6, CRP and polyamine oxidase in the input layer.
For the prediction of asymptomatic cerebral infarction, the sensitivity, the specificity,
the positive reaction predictive value, the negative reaction predictive value, the
positive likelihood ratio and the negative likelihood ratio were 95.5%, 94,3%, 93.3%,
96.2%, 16.86 and 0.05, respectively. The reaction predictive values and the likelihood
ratios were best improved, compared to the results in FIGs.1-3. Based on the results,
the use of the artificial neural network technique resulted in the improvement in
the judgment accuracy of the presence or absence of asymptomatic cerebral infarction.
Industrial Applicability
[0044] Cerebral stroke or asymptomatic cerebral infarction can be detected and diagnosed
early by using the detection method according to an aspect of the present invention.
Furthermore, a possibility of paving a new way for prophylaxis or early treatment
of a cerebral stroke and asymptomatic cerebral infarction, such as development of
a drug for prophylaxis or treatment of cerebral stroke and asymptomatic cerebral infarction,
is provided by exploring a compound that removes acrolein, polyamine oxidase, and
interleukin-6 and CRP which are inflammatory markers by utilizing the findings of
the invention.